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Physical and Mental Health Physical and mental health Health and Wellbeing Innovation Commission Inquiry Health and care Carers Care homes Social care Culture and society Community Retirement Infrastructure Retirement housing November 2018 Physical and mental health: health and wellbeing commission 1 Contents 1. Introduction 10 2. Setting the scene 11 3. Innovations in prevention and early daignosis 18 4. Innovations in self-management 29 5. Innovations in primary care 35 6. Innovations in secondary care 42 7. Barriers and opportunities 51 8. Recommendations 60 This report outlines key findings from a Health and Wellbeing Commission Enquiry, conducted by ILC, supported by EY and Audley. This report is one of four reports drawing together findings from evidence sessions held by the Commission during 2018. In our mental and physical health session we examined the potential for innovations which directly impact mental and physical health. We found there are significant gains to be made by increasing the rate of development, incubation and spread of innovation in this area. Sally Bowell Sally joined the International Longevity Centre as a Research Fellow in May 2017. Her work at the think tank has focused predominantly on health & social care, looking at topics such as music- based interventions for people with dementia, ageism in the breast cancer care pathway, and innovation in physical and mental health. 2 Physical and mental health: health and wellbeing commission Executive summary The benefits of innovation include improved quality of care, enhanced patient outcomes, and cost efficiencies. However, there are challenges to realising the potential of innovation in this area – and particularly in relation to moving from development to roll out and scaling. We identified innovations right across the care pathway. In the area of prevention and early diagnosis we found examples of simple and effective innovations that could deliver positive outcomes at relatively low cost. For example, falls account for a significant proportion of avoidable hospital admissions, but sensor technologies offer the potential for delivering low-cost and easy to implement falls risk assessments. Innovation can also play a role in nudging individuals towards positive health behaviours and in identifying at-risk cohorts early on so that resources can efficiently be directed on ensuring that these groups receive the best possible early interventions and care. For those already living with long-term conditions, there is also huge potential or innovation to support self-management. There were 15 million people in England living with long-term conditions in 2012 and this number is going to continue to increase. Innovative approaches include developing the role of pharmacies to take some of the strains away from GPs, or creating tools through which individuals can access advice and support to enable them to manage their conditions themselves. The Commission heard about Ask NHS – an app designed to allow individuals to check their symptoms, book appointments and find services. The Commission also identified potential for innovation inprimary care to reduce currently unsustainable demands on GPs. One potential area for development is in bringing together primary care professionals such as dentists and opticians alongside general practitioners nurses and others to reduce inefficiencies in the system. For example the Commission heard from Nailsea District Leg Club, which brings together a wide range of stakeholders and partners to support people living with leg conditions to manage Physical and mental health: health and wellbeing commission 3 their conditions and reduce social isolation. Initial assessment is provided by a nursing team, which is followed by weekly support. There is also a need for new ways of working in secondary care where current systems are under significant strain. Emergency care services often reflect the stresses on the system and in the last 5 years attendances at major A&E departments have increased by 7.9%, with an extra 3,000 people attending each day.1 Innovations are desperately needed across all elements of secondary care from delivery of urgent and emergency care to elective treatment to commissioning. One example where this has happened is the partnership between DeepMind Health, Moorfields Hospital, UCL, and Institute of Ophthalmology which has announced a five-year partnership to explore the use of an AI system which can make referral decisions for over 50 eye diseases. Innovation can also support the management of patient flows through hospitals, and improved interactions between all elements of the health and care systems. While there are significant opportunities for innovation to drive improvements in the everyday lives of patients, and cost savings for the health system, there are a number of barriers to their development, incubation and adoption: Barriers • While the health and care systems have got better at stimulating innovation, roll-out, scaling and diffusion remain more challenging due to the dispersed nature of commissioning across the health system and the lack of a defined mechanism for replication • The localised commissioning of health care, via CCGs, can result in the inconsistent acceptance of new innovations at local levels, and thus can be challenging for innovators. 1 Carl Baker (2018) House of Commons Briefing Paper, NHS Key Statistics: England, May 2018. Accessed at: http://researchbriefings.files.parliament.uk/documents/CBP-7281/CBP-7281.pdf 4 Physical and mental health: health and wellbeing commission • The health sector is generally risk-averse and is not culturally attuned to supporting innovation, and learning from failures • The NHS’s procurement procedures are complex and can be highly challenging to navigate for anyone new to the sector. • Proving the safety, effectiveness and cost-effectiveness of a new innovation in health can be both difficult and costly, and burden of proof is often excessive, with commissioners often rejecting innovations which are not backed by randomised control trials (RCTs), even when interventions are ill-suited to this kind of evaluation • The lack of interoperability between NHS systems is a significant challenge for innovators. Different parts of the health and care system continue to work in silos without speaking to one another, and this creates challenges for innovation • Despite a significant policy-drive towards innovation, little progress has been made. Policy-makers need to focus on creating clear and actionable policy frameworks and guidance, and supporting local areas and commissioners through longer- term funding and commitments. • The NHS has created culture in which piloted innovations must prove their worth in increasingly short timeframes in order to be adopted. Funding through programmes such as Vanguards often require programmes to generate results on unreasonable timescales and, as a result, promising innovations are stifled before they have time to flourish. • The uncertainty created by Brexit about the UK’s ability to attract and retain promising innovators, as well as high-performing clinical staff, may present challenges. Physical and mental health: health and wellbeing commission 5 Nevertheless, there are opportunities: • There is significant and growingengagement with the need for innovation across policy makers, clinicians and wider commentators. • Similarly, mechanisms such as the STP process are driving increasing collaboration which has the potential to smooth the pathway for innovation • There are many opportunity areas for innovation, with real opportunities to generate cost-efficiencies and to promote more effective working styles. • The 15 Academic Health Science Networks (AHSNs) are growing in strength and are already playing an important role in pioneering the spread and adoption of healthcare innovation. • There are opportunities for the UK to learn from experiences and developments in other countries, such as the FDA’s Pre-Cert Pilot Program in the US which is intended to support more rapid adoption of developments in digital technology. • There is huge potential to drawing patient advocates and professional membership bodies in to the innovation process – to ensure that innovation is informed by lived experience. • The Industrial Strategy promises increased GDP funding for R&D and sets out a strategy for developing homegrown innovations. • Algorithmic decision-making and big data are creating new opportunities for rapid innovation across the health and care system • The gradual development of national IT infrastructure offers a supportive environment for the wider roll-out of technology. 6 Physical and mental health: health and wellbeing commission Recommendations: • It is vital that the health system develops mechanisms to celebrate and reward scale up and diffusion, not just innovation • The health system needs to develop better mechanisms for weighing up and managing risk to more effectively support innovation and experimentation • We need to break down the real and perceived barriers (e.g. around data protection) to the development of consortia across the statutory, third and private sectors to support innovation • We need to change the conversation around innovation and innovators – so that increased demand on the NHS is seen as an opportunity not a burden, and start ups and SMEs feel welcome to become part of the solution • We need to provide further support for start-ups and SMEs innovating in health, in particular with regard to supporting them
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